[Stomatitis migrans].

Die stomatitis migrans ist eine oft beobachtete benigne Normvariante der Mundschleimhaut mit einer Prävalenz von 1.0-2.5%, wobei sie bei jungen Erwachsenen deutlich höher ist. Frauen sind häufiger betroffen. Die Ätiologie ist unbekannt, kommt aber in gleichen Familien gehäuft vor. Klinisch zeigen sich demarkierte, erythematöse Areale, die teilweise von einem gelblichen Saum umrandet sind.

Incidental findings in cone beam computed tomography (CBCT) scans for implant treatment planning: a retrospective study of 404 CBCT scans.

OBJECTIVES: To investigate the prevalence of incidental findings and need for further dental treatment and analyse the influence of size of field-of-view (FOV) and age in cone beam computed tomography (CBCT) for pre-implant planning. METHODS: 404 CBCT scans were examined retrospectively for incidental findings and need for further dental treatment. Incidental finding-frequencies and need for further treatment were assessed for different age (< 40 years, 40-60 years, > 60 years) and FOV groups (small, medium, large). Intraexaminer and interexaminer agreements were evaluated. RESULTS: In 82% of the scans at least one incidental finding was found, with a total of 766 overall. More incidental findings were found in scans with large FOV (98% vs. 72%, OR = 22.39 large vs. small FOV, p < 0.0001) and in scans of patients > 60 years (OR = 5.37 patient's age > 60 years vs. < 40 years, p = 0.0003). Further dental treatment due to incidental findings was needed in 31%. Scans with large FOV were more likely to entail further treatment (OR = 3.55 large vs. small FOV, p < 0.0001). Partial edentulism and large FOV were identified as risk factors for further treatment (p = 0.0003 and p < 0.0001). Further referral of the patient based on incidental findings was judged as indicated in 5%. Intra- and inter-examiner agreements were excellent (kappa = 0.944/0.805). CONCLUSIONS: A considerable number of incidental findings with need for further dental treatment was found in partially edentulous patients and in patients > 60 years. In pre-implant planning of elderly patients, the selection of large FOV CBCT scans, including dentoalveolar regions not X-rayed recently, help to detect therapeutically relevant incidental findings.

Prominent osteolysis in the maxilla: case report of an odontogenic fibroma mimicking a cyst.

BACKGROUND: Odontogenic fibroma (OF) is a rare benign odontogenic tumor of ectomesenchymal origin, mostly affecting the tooth-bearing portions of the jaws in middle-aged patients. Whilst small lesions tend to be clinically asymptomatic, varying unspecific clinical symptoms occur with an increase in size and may mimic odontogenic or other maxillofacial bone tumors, cysts, or fibro-osseous lesions of the jaws. CASE PRESENTATION: A 31-year-old female patient presented with a hard, non-fluctuating protrusion in the vestibule of the upper right maxilla. It was visualized on cone beam computed tomography (CBCT) as space-occupying osteolysis with the displacement of the floor and facial wall of the maxillary sinus, mimicking a cyst-like lesion. The tissue was surgically removed and identified as an OF in the histopathological examination. One year after the surgery, restitution of regular sinus anatomy and physiological intraoral findings were observed. CONCLUSIONS: This case report emphasizes that rare entities, like the maxillary OF presented, often demonstrate nonspecific clinical and radiological findings. Nevertheless, clinicians need to consider rare entities as possible differential diagnoses and plan the treatment accordingly. Histopathological examination is essential to conclude the diagnosis. OF rarely recur after proper enucleation.

A rare low-grade myofibroblastic sarcoma in lower jaw with the resemblance to benign lesions.

BACKGROUND: Low-grade myofibroblastic sarcoma (LGMS) is a rare solid infiltrative soft tissue tumor with a predilection for the head and neck region. CASE PRESENTATION: We report the diagnostic steps of a fast-growing lesion of the lower left jaw in a 45-year-old otherwise healthy woman. A first biopsy and subsequent histopathological examination showed potential differentials of a benign myofibroma, benign nodular fasciitis or an LGMS. This diagnostic overlap was a challenge for the decision of the further treatment approach. The treatment consisted of a segmental en bloc resection of the mandible including the second premolar, first and second molar. Histopathological examination of the resected tumor confirmed an LGMS. CONCLUSION: The histopathologic resemblance of LGMS to a range of benign and reactive tumors may lead to misdiagnosis and mistreatment. The rarity of LGMS explains the lack of established treatment protocols. This case shows the importance of adequate clinical decisions, expertise in the histopathology of rare tumors and interdisciplinary exchange to achieve state-of-the-art patient management.

The anatomical variability of the sphenoid sinus in CBCT - a retrospective study.

The aim of this retrospective study was to assess and illustrate the anatomical variability of the sphenoid sinus (SPS) on cone-beam computed tomography (CBCT) scans. A total of 50 SPS were assessed. CBCT images were oriented in the sagittal plane to evaluate the type of pneumatization (conchal, presellar, sellar and postsellar). Size measurements (width, length and height) of the SPS as well as the septation pattern and the presence or absence of pathologies were examined in all three planes. The postsellar type (28 cases, 56%) was the most common pattern of pneumatization. Conchal, presellar, or sellar pneumatization were significantly less frequent. There was only one case (2%) with a conchal and two cases (4%) with a presellar type. Multiple septa were found in 75% of patients with postsellar pneumatization, but only in 45.5% of patients featuring conchal, presellar or sellar type. In the postsellar category, all measured dimensions were significantly higher compared to the other types of pneumatization. Pathologies in the SPS were found in 7 patients (14%). It was concluded that the anatomical structure of the SPS is highly variable. Knowledge about its radiological appearance in CBCT will help in identification of pathologies and surrounding anatomical structures.

Impaired Taste Perception in Lichen Planus Patients with Tongue Involvement.

PURPOSE: To analyse the taste function in a pool of untreated patients with oral lichen planus (OLP) with tongue lesions (n = 35) and without tongue lesions (n = 36) and to compare it to healthy subjects (n = 36). MATERIALS AND METHODS: Firstly, the subjective overall taste ability and impairment of the sensations of 'sweet', 'sour', 'salty' and 'bitter' were recorded in all three groups. Secondly, taste function was tested in all included subjects using the standardised 'Taste Strips' test. RESULTS: Data showed a statistically statistically significant difference in overall taste perception between OLP patients with tongue lesions and control subjects (p = 0.027) for the tested taste function. The sensation of 'sour' showed the most pronounced difference (p = 0.08). The subjective taste perception and that of individual taste qualities did not differ statistically significantly between the three groups, and the correlation between subjective and objective taste perception was low. There was also a low correlation between taste scores and the presence of lesions on different areas of the tongue. CONCLUSION: For patients with OLP experiencing a loss in appetite, a formal taste examination and subsequent counselling should be considered.

Inter-Observer and Intra-Observer Variations in the Assessment of Epithelial Dysplasia in Oral Lichenoid Diseases.

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) can both present with histological dysplasia. Despite the presence of WHO-defined criteria for the evaluation of epithelial dysplasia, its assessment is frequently subjective (inter-observer variability). The lack of reproducibility in the evaluation of dysplasia is even more complex in the presence of a lichenoid inflammation. We evaluated dysplasia in 112 oral biopsies with lichenoid inflammation in order to study the inter-observer and the intra-observer variability.

Perforation of the maxillary sinus floor during apical surgery of maxillary molars: A retrospective analysis using cone beam computed tomography.

This retrospective analysis assessed a possible correlation of perforation of the maxillary sinus floor during apical surgery of maxillary molars and the distances from the treated apices/periapical radiolucencies to the sinus floor. The material included 168 apical surgeries of maxillary first or second molars performed from 1999 to 2016. In 22 (out of 33) perforation cases, a preoperative cone beam computed tomography (CBCT) was available. These cases were defined as the test group. From the pool of operated cases without sinus floor perforation, matching cases - that is, same treated tooth, similar age and same gender - were selected as a control group (N = 26). Mean linear distances from root apices or radiolucencies to sinus floor were significantly shorter in the test group compared to the control group. In conclusion, perforation cases were significantly closer to the sinus floor than cases without perforation.

Cone beam computed tomography artefacts around dental implants with different materials influencing the detection of peri-implant bone defects.

OBJECTIVES: To investigate the diagnostic accuracy of cone beam computed tomography (CBCT) for the diagnosis of peri-implant bone defects of titanium (Ti), zirconium dioxide (ZrO2 ) or titanium-zirconium (Ti-Zr) alloy implants. MATERIALS AND METHODS: Ti, Ti-Zr or ZrO2 implants with two diameters (3.3 mm, 4.1 mm) and one length (10 mm) were inserted in the angle of the mandible of six fresh defrosted pig jaws. Out of the 12 implants inserted, 6 served in the test group with standardized buccal peri-implant bone defects, whereas 6 served as control without bone defects. CBCTs were performed with three acquisition protocols (standard, high and low dose) using two devices. Four observers analysed CBCTs as follows: (a) presence of a peri-implant defect; (b) presence of peri-implant artefacts and impact on defect diagnosis; and (c) linear measurements of buccal peri-implant defect including height and width (in mm). RESULTS: CBCT device, CBCT settings, implant material, implant diameter and observer background did not significantly influence diagnostic accuracy. The sensitivity and specificity values were high for defect detection. ZrO2 led to a lower than average diagnostic accuracy (0.781). The linear measurements of peri-implant defect were underestimated by <1 mm on average. The subjective impact of artefacts on defect diagnosis was significantly affected by implant material and observer background. CONCLUSIONS: CBCT showed high diagnostic accuracy for peri-implant bone defect detection regardless of the device, imaging setting or implant material used. If CBCT is indicated to assess peri-implant bone disease, low dose protocols could be a promising imaging modality.

Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography.

OBJECTIVES: To compare ear, nose, and throat (ENT) specialists and dentists assessing health or pathology of maxillary sinuses using cone beam computed tomography (CBCT). MATERIAL AND METHODS: Two ENT specialists and two oral surgeons assessed 100 CBCT datasets of healthy patients referred for dental implant placement in the posterior maxilla and decided on the possibility of sinus floor elevation or the necessity for further diagnostic examinations based solely on radiographic findings. Inter-rater agreements within the same specialty were calculated with Cohen's kappa and overall agreements with Fleiss kappa, and factors influencing the decisions taken were evaluated using regression analyses. RESULTS: The correlation between all four raters was generally fair to moderate. The intra-specialty comparison showed a lower correlation between dentists than between ENT specialists. Absence of membrane thickening and total or subtotal sinus opacification showed the highest predictive value for a consensus in favor of sinus floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular surface morphology was associated with disagreement between the examiners. Dome-shaped membrane thickenings were often considered as to be referred by dentists but not by ENTs. CONCLUSION: The assessment of maxillary sinuses using CBCT imaging exhibited unsatisfactory agreement between ENT specialists and oral surgeons. Referral guidelines based on accidental CBCT findings that aim to diagnose relevant sinus pathologies early and avoid unnecessary diagnostics and/or therapies are needed, and an initial proposal for such recommendations is provided. Further research on correct interpretation of sinus findings and a validation of the present recommendations are required.

Proximity of Vascular Bone Channel in the Lateral Sinus Wall to Root Apices of Maxillary First Molars: A Cone-beam Computed Tomographic Analysis.

INTRODUCTION: Apical surgery is frequently indicated in maxillary first molars. Occasionally, a vascular anastomosis in the lateral maxillary sinus wall can be observed during surgery. The aim of this study was to examine the distance between the vascular bone channel (VBC) and the root apices of maxillary first molars using cone-beam computed tomographic imaging. METHODS: Cone-beam computed tomographic images of 104 maxillary first molars were oriented in the coronal plane to evaluate the distance between the roots and the VBC. The measurements were only recorded in relation to the buccal roots. In addition, demographic parameters and further measurements such as the diameter of the VBC and the proximity to the periapical pathology were evaluated. RESULTS: A total of 210 VBCs were assessed. The mean distance from the VBC to the apices of the buccal roots of the maxillary first molars was 6.18 mm ± 3.84 mm. The VBC was mostly located intrasinusally (74.3%) and only rarely superficially (0.5%). The diameter of the VBC was on average 0.88 ± 0.32 mm. CONCLUSIONS: In this study, the VBC was usually found closer to the mesiobuccal than to the distobuccal root apex. During preparation of the access window, the existence of the VBC should be kept in mind because the mesiobuccal roots of maxillary first molars undergo apical surgery to the buccally positioned roots only.

Comparative evaluation of SPECT/CT and CBCT in patients with mandibular osteomyelitis and osteonecrosis.

OBJECTIVES: Therapy of osteomyelitis and osteonecrosis very often requires surgery. Proper preoperative radiological evaluation of a lesion's localization and extent is a key in planning surgical bone resection. This study aims to assess the differences between single-photon emission computed tomography and cone beam computed tomography when detecting an osteomyelitis/osteonecrosis lesion as well as the lesion's qualitative parameters, extent, and localization. MATERIAL AND METHODS: Identification of candidates was performed retrospectively following a search for patients with histologically or clinically confirmed osteomyelitis or osteonecrosis. They were matched with a list of patients whose disease extent and localization had been evaluated using single-photon emission computed tomography and cone beam computed tomography in the context of clinical investigations. Subsequently, two experienced examiners for each imaging technique separately performed de novo readings. Detection rate, localization, extent, and qualitative parameters of a lesion were then compared. RESULTS: Twenty-one patients with mandibular osteomyelitis and osteonecrotic lesions were included. Cone beam computed tomography detected more lesions than single-photon emission computed tomography (25 vs. 23; 100% vs. 92%). Cone beam computed tomography showed significantly greater depth, area, and volume, whereas length and width did not differ statistically between the two groups. CONCLUSION: Both single-photon emission computed tomography and cone beam computed tomography could sensitively detect osteomyelitis/osteonecrosis lesions. Only single-photon emission computed tomography showed metabolic changes, whereas cone beam computed tomography seemed to display anatomic morphological reactions more accurately. The selection of the most adequate three-dimensional imaging and the correct interpretation of preoperative imaging remains challenging for clinicians. CLINICAL RELEVANCE: In daily clinical practice, three-dimensional imaging is an important tool for evaluation of osteomyelitis/osteonecrosis lesions. In this context, clinicians should be aware of differences between single-photon emission computed tomography and cone beam computed tomography when detecting and assessing an osteomyelitis/osteonecrosis lesion, especially if a surgical bone resection is planned.

Is the pneumatisation of the maxillary sinus following tooth loss a reality? A retrospective analysis using cone beam computed tomography and a customised software program.

OBJECTIVES: To compare the dimensions of maxillary sinuses in dentate and edentulous patients using cone beam computed tomography (CBCT) scans and a customised software program. MATERIALS AND METHODS: This study comprised CBCTs of 50 dentate and 50 edentulous posterior maxillae. The observers drew two planar curves in all included sinuses in the frontal, sagittal and axial planes of the respective CBCT scans. The volume (mm3), surface (mm2) and maximum diameter (mm) of the sinuses were calculated using a custom-made software program. The variables analysed were the influence of the state of dentition on sinus dimensions (primary outcome) and the influence of age, gender and side on sinus dimensions; the time needed for analysis; and the intra- and inter-observer agreement (secondary outcomes). RESULTS: There was no difference in sinus dimensions between dentate and edentulous posterior maxillae. Males had significantly (p < 0.05) greater volume, surface and diameter than females. Strong intra- and inter-observer agreement (Pearson correlation) was found for the calculated sinus dimensions. The time needed per analysis was less than 4 min for both observers. CONCLUSIONS: Being edentulous did not have an impact on the sinus dimensions, suggesting that there is no ongoing pneumatisation in the sinus after tooth loss. Males had larger sinuses than females in a population older than 30 years. CLINICAL RELEVANCE: Following tooth loss in the posterior maxilla, vertical bone height is primarily lost due to resorption of the alveolar crest, and not due to pneumatisation of the maxillary sinus. The customised software program was found to be user-friendly and efficient.

Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review.

The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7-90 for the laser and 5-90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO2 laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO2 laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

A randomized controlled clinical and histopathological trial comparing excisional biopsies of oral fibrous hyperplasias using CO2 and Er:YAG laser.

This study was conducted in order to compare clinical and histopathological outcomes for excisional biopsies when using pulsed CO2 laser versus Er:YAG laser. Patients (n = 32) with a fibrous hyperplasia in the buccal mucosa were randomly allocated to the CO2 (140 Hz, 400 µs, 33 mJ) or the Er:YAG laser (35 Hz, 297 µs, 200 mJ) group. The duration of excision, intraoperative bleeding and methods to stop the bleeding, postoperative pain (VAS; ranging 0-100), the use of analgesics, and the width of the thermal damage zone (µm) were recorded and compared between the two groups. The median duration of the intervention was 209 s, and there was no significant difference between the two methods. Intraoperative bleeding occurred in 100% of the excisions with Er:YAG and 56% with CO2 laser (p = 0.007). The median thermal damage zone was 74.9 µm for CO2 and 34.0 µm for Er:YAG laser (p < 0.0001). The median VAS score on the evening after surgery was 5 for the CO2 laser and 3 for the Er:YAG group. To excise oral soft tissue lesions, CO2 and Er:YAG lasers are both valuable tools with a short time of intervention and postoperative low pain. More bleeding occurs with the Er:YAG than CO2 laser, but the lower thermal effect of Er:YAG laser seems advantageous for histopathological evaluation.

Gustatory function and taste perception in patients with oral lichen planus and tongue involvement.

OBJECTIVES: The aim of the study was to evaluate if patients with oral lichen planus (OLP) and tongue involvement have impaired taste function and if there is an association to the perception of pain. MATERIAL AND METHODS: The test group included patients with OLP and involvement of the tongue without treatment (n = 20). Control subjects had no mucosal or systemic disease affecting taste function and were matched for age and gender (n = 20). Patients' intraoral pain and subjective perception of taste were recorded on a visual analog scale. Taste function was assessed by means of the "taste strips." RESULTS: Measured taste function was slightly but significantly decreased in OLP patients compared to control subjects (p = 0.01). Self-rated taste perception did not differ in both groups (p = 0.8). Post hoc analysis showed that particularly the taste quality "sour" was most affected by the OLP status (p = 0.01). There were no correlations between pain and subjective/objective taste perception. CONCLUSION: Untreated OLP subjects have lower gustatory function, which they are not aware of. CLINICAL RELEVANCE: Impaired gustatory function in patients with OLP may affect patient's quality of life. Further studies on larger samples sizes are requested.